tbuckley/cabot-search huggingface dataset:
Abstract 9789: Geriatric Nutritional Risk Index Predicts Bleeding Event in Patients With Heart Failure
Authors: Yu Sato, Akiomi Yoshihisa, Yuji Nozaki, Himika Ohara, Yukiko Sugawara, Satoshi Abe, Tomofumi Misaka, Takamasa Sato, Masayoshi Oikawa, ATSUSHI KOBAYASHI, Takayoshi Yamaki, Kazuhiko Nakazato, Yasuchika Takeishi
Journal: Circulation (2022)

Introduction: The relationship between malnutrition and bleeding event has been unclear in patients with heart failure (HF). Method and Results: We evaluated the nutritional status of patients with HF (n = 2,044) using Geriatric Nutritional Risk Index (GNRI). The primary endpoint was composite bleeding event of hemorrhagic stroke or gastrointestinal bleeding. According to the survival classification and regression tree analysis, the accurate cut-off point of GNRI for predicting the primary endpoint was 106.2. We divided patients into two groups based on GNRI levels: the High GNRI group (GNRI ≥ 106.2, n = 606, 29.6%) and the Low GNRI group (GNRI &lt; 106.2, n = 1,438, 70.4%), and compared patients’ characteristics and prognosis between the two groups. The Low GNRI group showed higher age (72.0 vs. 63.0 years, P &lt; 0.001) and lower prevalence of male sex (56.9% vs. 64.5%, P = 0.001) than the High GNRI group. There were no differences in use of antiplatelet agents and anticoagulants between the groups. In laboratory data, levels of B-type natriuretic peptide were higher in the Low GNRI group (321.1 vs. 111.6 pg/mL, P &lt; 0.001). Left ventricular ejection fraction was comparable between the groups. The Kaplan-Meier analysis demonstrated that bleeding event rates were higher in the Low GNRI group than in the High GNRI group (Figure, log-rank P &lt; 0.001). The multivariable Cox proportional hazard analysis revealed that the Low GNRI was independently associated with bleeding events (hazard ratio 1.795, P = 0.047). Conclusions: Malnutrition assessed by GNRI predicts bleeding events in patients with HF.
Abstract 9390: Cardiac Geometry, Function, and Mechanics in Biventricular Takotsubo Syndrome
Authors: Ricardo de la Villa, Ruben Porudominsky, Matthew Lozier, Daniela Urina, Francisco Ujueta, Christos Mihos
Journal: Circulation (2022)

Introduction: Approximately 30% of patients with Takotsubo syndrome have biventricular involvement (BiV-TTS), which confers an increased morbidity. This study aimed to detail cardiac geometry, function and mechanics in BiV-TTS. Methods: Twenty-five patients diagnosed with BiV-TTS according to the InterTAK diagnostic criteria between 2006 to 2020 were retrospectively identified and analyzed with 2-dimensional and speckle-tracking strain echocardiography. An independent t-test, Mann-Whitney U-test, or Kruskal-Wallis test were used for the statistical analyses. Results: Mean age was 71.1 ± 17.9 years, and 56% were female. The LV ejection fraction was decreased (31.4 ± 12.2%), chamber size was increased (end-systolic volume index: 41.3 ± 10.2 ml/m2), and 48% had concentric remodeling. The right ventricular (RV) size was upper normal (40.6 ± 4.1 mm), and tricuspid annular plane systolic excursion was decreased (12.0 ± 2.6 mm). Sixteen patients had suitable images for speckle-tracking analysis. Global LV longitudinal strain was impaired (-7%, IQR -9.6 to -4.5), with significant differences between basal (-7.1%), mid (-4.3%), and apical (-0.2%) territories (P=0.001). Segmental strain within the LV base statistically varied, with the anteroseptum most impaired (-3.1%) and the inferolateral segments most preserved (-11%) (p=0.01). RV free wall strain was impaired (-9.9% ± 4.7), and differed between basal (-14.6%), mid (-11.9%), and apical (-5.4%) territories (P&lt;0.001). Females had worse global LV (-4.6 vs. -9.5%, p=0.02) and similar RV free wall strain (-9.6 vs. -10.2%, p=0.78) impairment compared with males. Conclusions: Chamber remodeling, dysfunction, and mechanical impairment characterize BiV-TTS. Important differences exist in territorial and segmental strain values, and between genders.
Abstract 9445: Using Latent Class Analysis to Identify Antihypertensive Adherence Trajectories: The BETTER-BP Trial
Authors: Eleonore V Grant, Kun Qian, Samrachana Adhikari, Yasmin Guttierez, Daichi Shimbo, Natali Levy, Anamarija Fonceva, John A Dodson
Journal: Circulation (2022)

Introduction: Adherence to antihypertensive medications remains low in many patients. In this context, the BETTER-BP randomized trial was designed to test whether providing small financial rewards for medication adherence with a text message-based lottery system improves adherence and lowers blood pressure. In this preliminary analysis we characterized adherence trends from baseline to 6 months in BETTER-BP through 12/2021. Methods: Participants were recruited from two safety-net clinics in New York City (Bellevue Hospital and NYU-Brooklyn FHC). There were 101 participants with six months of complete adherence data. Mean weekly adherence was recorded through an Adheretech electronic monitoring device. Latent class mixed methods analysis was used to determine categorizable adherence trajectory trends over six months. We then investigated factors (age, sex, insurance status, comorbidity burden, depression, self-efficacy) that predicted category membership. The analysis remained blinded to treatment arm given that full enrollment was not yet complete. Results: Three distinct adherence trajectories were determined: (1) High, persistent adherence (n=53), (2) Gradually declining adherence (n=33), and (3) Early declining non-adherence (n=15). In a multivariable analysis, only self-efficacy (based on the medication adherence self-efficacy scale [MASES]) had a significant (p=0.02) association with adherence, with mean MASES scores of 81.4, 76.3 and 72.1 for clusters (1), (2) and (3) respectively. Conclusions: In this preliminary analysis, we found that the majority of participants had high persistent adherence, and that those with high self-efficacy were more likely to be members of this category. These results will need to be confirmed at trial completion (target sample N = 435). Figure 1. Mean participant adherence trajectory clusters over six months.
Abstract 9360: <sup>18</sup> F-Sodium Fluoride Positron Emission Tomography Following Coronary Computed Tomography Angiography in Predicting Major Coronary Events: A 5-year Longitudinal Study
Authors: Toshiro Kitagawa, Ko Sasaki, Yuto Fujii, Yuki Ikegami, Fuminari Tatsugami, Kazuo Awai, Yutaka Hirokawa, Yukiko Nakano
Journal: Circulation (2022)

Background: The predictive value of 18 F-sodium fluoride ( 18 F-NaF) positron emission tomography (PET) for coronary events has attracted interest. We evaluated the usefulness of 18 F-NaF PET following coronary computed tomography (CT) angiography (CCTA) in predicting major coronary events (CEs) during a 5-year period. Methods: This study included 40 patients with ≥1 coronary atherosclerotic lesion detected on CCTA who underwent 18 F-NaF PET/CT. Each lesion was evaluated with luminal stenosis and the presence of high-risk plaque (HRP) defined as plaque with low density (&lt;30 Hounsfield units) and high remodeling index (&gt;1.1). Focal 18 F-NaF uptake in each lesion was quantified using maximum tissue-to-background ratio (TBR max ), and maximum TBR max per patient (M-TBR max ) was determined. We followed CEs (cardiac death, acute coronary syndrome, and/or coronary revascularization &gt;6 months after 18 F-NaF PET/CT scan) for 5 years. Results: A total of 142 coronary lesions were analyzed. Eleven patients (28%) experienced any CE: 1 had sudden cardiac death, 1 had myocardial infarction, 3 had unstable angina requiring hospitalization, and 6 underwent late coronary revascularization. The frequencies of ≥70% stenosis (64% vs. 55%, p = 0.63) and HRP (83% vs. 62%, p = 0.23) on CCTA were not different between patients with CE and those without. Patients with CE showed a higher M-TBR max (1.40 ± 0.19 vs. 1.18 ± 0.18, p = 0.0011), and its optimal cutoff to predict future CE was 1.29 (area under curve 0.79). Patients with ≥1.29 M-TBR max had a higher risk of CE than those without (Fig 1), whereas patients with ≥70% stenosis and those with HRP did not (Fig 2). Multivariate Cox proportional analysis adjusted for age, sex, the presence of coronary risk factors, and CCTA findings showed that ≥1.29 M-TBR max remained as an independent predictor of the 5-year CE (hazard ratio, 5.4; 95% CI, 1.1-25.4; p = 0.034). Conclusions: 18 F-NaF PET following CCTA has a promising potential to predict long-term CEs.
Abstract 9559: Isolated Functional Tricuspid Regurgitation: Importance of Atrial Fibrillation and Right Atrial Remodeling and Prognostic Significance
Authors: SOON GU KWAK, Jaehyun Lim, You-Jung Choi, Jun-bean Park
Journal: Circulation (2022)

Aim: We aimed to identify the risk factors for progression from mild tricuspid regurgitation (TR) to significant isolated functional TR (FTR) in relation to atrial fibrillation (AF) and assess its prognostic implications. Background: Isolated FTR is an increasingly recognized type of TR, but little is known about the determinants and outcomes. Method: We retrospectively studied 833 patients who had mild TR at baseline echocardiography and underwent follow-up echocardiography at least 1-year apart. Significant TR was defined as ≥moderate TR. Isolated FTR was defined as TR with no overt cause. Patients were stratified by the baseline AF. The Mantel-Byar test was used to compare the clinical outcomes according to significant TR progression. Result: Of 833 patients with mild TR, 291 patients (34.9%) had AF. During the median 4.6 years, significant TR developed in 35 patients, including 33 isolated FTRs, which were markedly higher in patients with AF than in those without (11.0% vs. 0.6%, P &lt;0.001). In Cox analysis, AF was a strong risk factor for isolated FTR progression (adjusted hazard ratio: 7.97, 95% confidence interval: 2.26–28.12, P =0.001). Among AF patients, those who developed significant isolated FTR had a larger baseline right atrium (RA) area (23.8 vs. 19.1 cm 2 , P &lt;0.001) and area ratio of RA to right ventricle at end-systole (3.0 vs. 2.3, P &lt;0.001) than those who did not. These parameters were also independent predictors of isolated FTR progression. The 10-year cumulative major adverse cardiovascular event was significantly higher after isolated FTR progression than before or without progression (79.8% vs. 8.6%, Mantel-Byar P &lt;0.001). Conclusion: In patients with mild TR, significant isolated FTR developed predominantly in AF patients. RA enlargement, especially with a higher RA to right ventricle end-systolic area ratio, was a strong risk factor for isolated FTR progression in AF patients. Patients with significant isolated FTR conferred poor prognosis.
Abstract 9777: Percutaneous Ambulatory Biventricular Support With Protekduo and Impella: A Community Hospital Experience
Authors: Sankalp P Patel, Brian J Solomon, Shona V Velamakanni, Elsy V Navas, Robert J Cubeddu, Gaston A Cudemus
Journal: Circulation (2022)

Introduction: With the advent of percutaneous MCS devices, like the Abiomed ® Impella TM LVAD and Livanova ® ProtekDuo TM RVAD, patients with biventricular failure necessitating ECLS can be transitioned to a fully ambulatory femoral-free BIVAD configuration. Case: A 60-year-old man presented with atrial fibrillation. He underwent TTE revealing EF &lt;20%. After cardiac cath ruled out ischemic cause, he underwent TEE with plan for cardioversion. Upon induction, he suffered a PEA arrest and VA- ECMO support promptly ensued, per ECLS protocol, with b/l femoral cannulation. An Impella TM CP LVAD was also inserted to provide unloading and further support. After 2-days with b/l groin ECMO cannulation with femoral percutaneous LVAD, the patient awoke, displaying adequate urine output and following of basic commands. Transition was made from femoro-femoral cannulation to percutaneous right-IJ ProtekDuo TM RVAD attached to a Quadrox-i ® oxygenator for ECMO support, along with transition of femoral Impella TM CP to a robust axillary Impella TM 5.5 LVAD (Figure). This configuration decannulated the groins, permitting the patient to work with physical therapy. Discussion: Transition to groin-free configuration with percutaneous BIVAD apparatus implementing the ProtekDuo TM RVAD with Impella TM 5.0/5.5 axillary LVAD has only been reported at a large cardiovascular institute in Germany. That case series highlighted how percutaneous ambulatory BIVAD allowed for rapid extubation, early mobilization, and minimal complications 1 . Herein, we demonstrated the first presumed community-hospital experience with this underreported mechanical circulatory support combination promoting a pathway to rehabilitation and eventual transplantation. Conclusion: This report showcases the feasibility of adapting percutaneous ambulatory BIVAD with a combined ProtekDuo TM /Impella TM groin-free apparatus in the community-hospital setting.
Abstract 9349: Procedural Characteristics of Intravascular Ultrasound-Guided Percutaneous Coronary Intervention and Their Clinical Implications
Authors: Seung-Yul Lee, Junjie Zhang, Gary S Mintz, Shao-Liang Chen, Myeong-Ki Hong
Journal: Circulation (2022)

Introduction: Despite the clinical benefits to intravascular ultrasound (IVUS) guidance for percutaneous coronary intervention (PCI), most patients with coronary artery disease undergo angiography-guided PCI alone in real world. Hypothesis: We sought to investigate the procedural characteristics of IVUS-guided PCI and their clinical outcomes, as compared with angiography-guided PCI. Methods: This was a cohort study using patient-level data from IVUS-XPL and ULTIMATE clinical trials. A total of 2,848 patients with 3,872 native coronary lesions were included and procedural characteristics assessed by quantitative coronary angiography (QCA) were compared between IVUS and angiography guidance. Results: Stent-to-reference vessel diameter ratio (i.e., QCA stent sizing) was greater (1.11±0.16 vs 1.07±0.14, p&lt;0.001) and high-pressure post-dilation was more frequently performed (83.7% vs 75.4%, p&lt;0.001) with IVUS guidance, whereas residual stent edge dissections were more frequent in lesions treated with IVUS guidance (4.6% vs 0.7%, p&lt;0.001). Given the dissection risk, optimal QCA stent sizing for IVUS guidance was a stent-to-QCA reference vessel diameter ratio ≥1.1 to &lt;1.3. Among 1,424 patients (1,969 lesions) treated with angiography guidance, QCA stent sizing &lt;1.0 was observed in 651 (33.1%) lesions while QCA stent sizing ≥1.1 to &lt;1.3 was observed in only 526 (26.7%) lesions. Under angiography guidance, patients with both QCA stent sizing ≥1.1 to &lt;1.3 and high-pressure post-dilation (235/1,424, 16.5%) had a lower risk of 3-year target lesion failure compared with others (hazard ratio=0.532, 95% confidence interval=0.293-0.966, p=0.038). Conclusions: IVUS-guided PCI resulted in larger QCA-assessed stent sizing and more frequent post-dilation with high-pressure inflations. These procedures may further improve long-term clinical outcomes in patients undergoing PCI without IVUS.
Abstract 9418: Inhibition of Cardiac Mitochondrial Fission as an Effective Intervention Against Trastuzumab-Induced Cardiotoxicity in Rats
Authors: Chayodom Maneechote, Thawatchai Khuanjing, Benjamin Ongnok, Apiwan Arinno, Nanthip Prathumsap, Titikorn Chunchai, Busarin Arunsak, Sasiwan Kerdphoo, Siriporn Chattipakorn, Nipon Chattipakorn
Journal: Circulation (2022)

Introduction: Trastuzumab (TRZ) has been broadly used as a chemotherapeutic agent for the treatment of advanced human epidermal growth factor receptor type 2-expressing malignancies. However, cardiotoxicity exacerbated by TRA has become an adverse clinical manifestation of oncologic treatment. Although cardioprotective outcomes of a mitochondrial division inhibitor (Mdivi-1) have been demonstrated for a wide range of cardiovascular pathologies, the anti-cardiotoxic effects of Mdivi-1 against TRZ are unknown. Hypothesis: Treatment with Mdivi-1 rescues cardiac mitochondrial dysfunction, resulting in improved left ventricular (LV) function in rats with TRZ-induced cardiotoxicity. Methods: Male Wistar rats (n=18) were divided into either TRZ group (4 mg/kg/day for 7 days, I.P., n=12) or control group (CON, n=6). In the TRZ group, rats also received one of the following co-treatments: 1) vehicle (VEH, n=6) or 2) Mdivi-1 (MDV, 1.2 mg/kg/day, n=6) via I.P. injection for 7 days. LV ejection fraction (LVEF) and cardiac mitochondrial function were determined. Results: TRZ-treated rats had impaired cardiac mitochondrial function as shown by increased reactive oxygen species (ROS) production, mitochondrial depolarization (reduced red/green fluorescence intensity), and mitochondrial swelling (reduced absorbance intensity), leading to LV dysfunction (75% LVEF for TRZ vs. 88% LVEF for CON) (Fig. 1A-D). Mdivi-1 co-treatment attenuated cardiac mitochondrial dysfunction and LV dysfunction as evidenced by a decrease in ROS, mitochondrial depolarization, mitochondrial swelling, and increased LVEF (83%, 11% improvement from VEH group) (Fig. 1A-D). Conclusions: Mdivi-1 effectively protected the heart against TRZ-induced cardiotoxicity by attenuating mitochondrial and LV dysfunction, thus indicating that pharmacological inhibition of mitochondrial fission could be a novel anti-cardiotoxicity in TRZ-induced cardiotoxicity.
Abstract 9568: Sodium-Glucose Cotransporter 2 Inhibitors Prevent New-Onset Type 2 Diabetes in Adults With Prediabetes: Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Yuichiro Mori, Obidiugwu K Duru, Katherine R Tuttle, Shingo Fukuma, Daisuke Taura, Norio Harada, Nobuya Inagaki, Kosuke Inoue
Journal: Circulation (2022)

Introduction: Although the preventive effect of sodium-glucose cotransporter 2 (SGLT2) inhibitors for new-onset diabetes was investigated as secondary analyses of recent randomized controlled trials (RCTs), the synthesized evidence is lacking. We thus aimed to summarize the effects of SGLT2 inhibitors on preventing new-onset diabetes. Hypothesis: We assessed the hypothesis that SGLT2 inhibitors reduce the incidence of diabetes among patients with prediabetes and heart failure or chronic kidney disease. Methods: In this systematic review and meta-analysis of RCTs, MEDLINE and EMBASE were searched through February 11, 2022. Two independent authors screened the search results and extracted data from eligible RCTs (including both original and post hoc analyses) comparing SGLT2 inhibitors and placebo for the risk of new-onset diabetes among adults with prediabetes. No restrictions on publication date and language were applied. Meta-analysis was conducted using random-effects models to calculate risk ratios and 95% confidence intervals (CIs). Results: We included 4 RCTs with 5655 participants who had prediabetes. All studies had a low risk of bias and were conducted for treatments of heart failure or chronic kidney disease. Based on the random-effects meta-analysis, SGLT2 inhibitors were significantly associated with a lower risk of new-onset diabetes (relative risk, 0.79; 95% CI, 0.68 to 0.93, I2 =0·0%). The relative risks of new-onset diabetes in dapagliflozin and empagliflozin were 0.68 (95% CI, 0.52 to 0.89) and 0.87 (95% CI, 0.72 to 1.04), respectively (p-for-heterogeneity =0.14). The frequency of severe hypoglycemia was not elevated in the SGLT2 inhibitors group compared to the placebo group. Conclusions: In this meta-analysis, SGLT2 inhibitors were associated with a reduced risk of new-onset type 2 diabetes among adults with prediabetes and heart failure or chronic kidney disease. These findings indicate the potential usefulness of SGLT2 inhibitors as a pharmaceutical approach to prevent diabetes in conjunction with lifestyle modification among high-risk adults with prediabetes.
Abstract 9757: Real World Experience With Anticoagulation in Atrial Fibrillation Patients After Pulmonary Vein Isolation: Associations With Cha <sub>2</sub> Ds <sub>2</sub> -vasc Score, Sex and Maintenance of Sinus Rhythm
Authors: Tom Kai Ming K Wang, Nicholas Chan, Paul C Cremer, Mohamed H Kanj, Bryan Baranowski, Walid I Saliba, Oussama M Wazni, Wael A Jaber
Journal: Circulation (2022)

Background: Guidelines recommend using the CHA 2 DS 2 -VASc score to determine anticoagulation decisions in atrial fibrillation (AF) patients, including those who undergo pulmonary vein isolation (PVI), however this may not consistently occur in the real-world setting because of other clinical factors. We sought to evaluate the anticoagulation prescription patterns in AF patients 1 year PVI at our institution. Methods: Consecutive AF patients undergoing PVI in our prospective registry during 2014-2018 who were alive at 1-year post-PVI were studied. Anticoagulation prescription rates at this time-point were adjudicated, and correlated to CHA 2 DS 2 -VASc score, sex and maintenance of normal sinus rhythm (NSR) at 1 year. Results: Amongst 4596 patients undergoing PVI, mean age was 64.1±10.0 years, 3308 (71.2%) were male, and based on CHA 2 DS 2 -VASc Score anticoagulation was not indicated, can be considered and indicated in 872 (19.0%), 1183 (25.7%) and 2541 (55.3%) patients respectively. At 1-year after PVI, 3504 (76.2%) patients were on anticoagulation, and 792 (17.2%) had recurrence of AF. Anticoagulation rates by sex, CHA 2 DS 2 -VASc Score category and NSR at 1-year after PVI are illustrated in the Figure. Anticoagulation was continued in over half of AF patients without classic CHA 2 DS 2 -VASc indication particularly in those with AF recurrence and women, while they were mildly under-prescribed in those with indication, especially for those without AF recurrence and men. Conclusion: In a large real world cohort of patients post PVI, anticoagulation is prescribed independent of CHA 2 DS 2 -VASc score, and is affected by both sex and NSR status. Factors determining continuous anticoagulation after successful PVI may include parameters not covered in the CHA 2 DS 2 -VASc score such as return of atrial mechanical function on echocardiography, valve disease or extra-cardiac pathologies.